Provider Demographics
NPI:1508614116
Name:DIMAYUGA, CLARINA MARIEL MENDOZA (RBT, LABA)
Entity Type:Individual
Prefix:
First Name:CLARINA MARIEL
Middle Name:MENDOZA
Last Name:DIMAYUGA
Suffix:
Gender:U
Credentials:RBT, LABA
Other - Prefix:
Other - First Name:RINA
Other - Middle Name:
Other - Last Name:DIMAYUGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15728 NE 105TH CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13333 NE BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2332
Practice Address - Country:US
Practice Address - Phone:425-215-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst